Key result
Conduction system pacing appears a viable alternative to BiV CRT in AF following AV node ablation.
Why the study?
Despite increasing popularity, conduction system pacing has rarely been specifically examined in patients with atrial fibrillation.
Does conduction system pacing improve outcomes compared to conventional biventricular pacing in patients with atrial fibrillation?
Does conduction system pacing improve outcomes compared to conventional biventricular pacing in patients with atrial fibrillation?
Conduction system pacing, particularly left bundle branch pacing, is a promising alternative to conventional biventricular pacing in patients with atrial fibrillation undergoing AV node ablation, though large randomized trials are needed.
Answers are grounded in this paper and cite their sources.
May support conduction system pacing as alternative in AF post-AVNA; leaves open confirmation of benefit versus biventricular pacing in RCTs.
Conduction system pacing (CSP) has emerged as a promising novel delivery method for Cardiac Resynchronisation Therapy (CRT), providing an alternative to conventional biventricular epicardial (BiV) pacing in indicated patients. Despite increasing popularity and widespread uptake, CSP has rarely been specifically examined in patients with atrial fibrillation (AF), a cohort which forms a significant proportion of the heart failure (HF) population. In this review, we first examine the mechanistic evidence for the importance of sinus rhythm (SR) in CSP by allowing adjustment of atrioventricular delays (AVD) to achieve the optimal electrical response, and thus, whether the efficacy of CSP may be significantly attenuated compared to conventional BiV pacing in the presence of AF. We next evaluate the largest clinical body of evidence in this field, related to patients receiving CSP following atrioventricular nodal ablation (AVNA) for AF. Finally, we discuss how future research may be designed to address the vital question of how effective CSP in AF patients is, and the potential hurdles we may face in delivering such studies.
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Wijesuriya et al. (2023) conducted a review in Atrial fibrillation and heart failure requiring cardiac resynchronization therapy. Conduction system pacing (His-bundle and left bundle branch pacing) vs. Conventional biventricular pacing was evaluated. Conduction system pacing appears to be a viable alternative to conventional biventricular pacing for cardiac resynchronization therapy in patients with atrial fibrillation, particularly following atrioventricular node ablation.
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